Clinical Characteristics And Related Factors Of Cognition Rehabilitation In Post-stroke Patients With Aphasia

BackgroudAphasia is a common brain disorder which assumes language function impairment(like listsening,speaking,reading,writing and so on),and it is present in nearly 1/3 of individuals with acute stroke.Because there are few appropriate neuropsychological cognitive assessments for post-stroke aphasia patients,the nonlinguistic cognition of them have always been neglect in clinical.Studies have investigated that 86%aphasic patients had nonligustic cognition impairment in acute phase and 88%patients had impairments in at least one nonlinguistic cognitive domain at 3 months after stroke.Curiously,the prevalence of cognition dysfunction in patients without aphasia after stroke is about 47.3%-56.6%,far below aphasia patients.Unfortunately,many commonly used neuropsychological assessment tests,for example,MMSE and MoCA,need linguistic processing and/or production demands,thus they are not suitable for the aphasia patients.Some assessments,like Aphasia Check List(ACL),maybe fitted in aphasia patients,but it has not been revised in China let alone reliability and validity test.So we developed Non-language-based Cognitive Assessment(NLCA)to evaluate the nonlingustic cognition of post-stroke aphasia patients.It contains five main cognitive domains such as memory,visuoapatial function,reasoning,attention and executive functions and it’s a reliable and valid cognitive assessment test battery.Now NLCA will be applied to a short-term follow-up study of cognition in post-stroke aphasia patients,in order to explore the clinical characteristics and potential influencing factors of rehabilitation of cognition.Besides,to further analyze the complex relationship between language and other cognition.ObjectiveTo study the clinical characteristics and potential influencing factors of rehabilitation of cognition in post-stroke aphasia(PSA)patients.Methods Patients with aphasia after ischemic stroke,admitted in the department of Neurology in our Hospital from June 2015 to November 2016 were included.Inclusion criterion:(1)Fit the diagnosis criterion established by the Fourth National Cerebrovascular Disease Academy Conference;(2)Over 7 days after onset and on the stable condition;(3)Clear conscious to finish the examination;(4)Confrimed by brain CT or MRI;(5)Patient and there relatives in know and agree to participate in this experiment.Exclusion criterion:(1)Too serious to cooperate the examination;(2)Have severe psychiatric disorder exclude depression and anxiety;(3)Have had a stroke or cognition impairment before onset.Register the primary clinical information(like name,sex,nation,age,marriage status,occupation,educational years,etc)of patients who are in accordance with the inclusion criteria.Besides,record their NIHSS scores,related examination especially MR/CT results.In acute phase,Aphasia Battery of Chinese(ABC)was used to evaluate language ability and classify the aphasia type.Non-language-based Cognitive assessment(NLCA)was used to assess patients’ nonlinguistic cognition such as memory,visual spatial ability,logic reasoning,attention and executive ability.We assessed depressive emotion by Stroke Aphasic Depression Questionnaire Hospital Version(SADQ-H)and dependence degree by activities of daily living scale(ADL).In 3 months after stroke onset,patients need to accept these evaluations all again.All of subjects finished by trained postgraduate major in neurology in a quiet room face to face.41 ischemic patients were selected in our study,and remain thirty aphasia patients in 3-month follow-up,with 24 male and 6 famale.(1)Age(55.70±15.11)years;course of disease(9.40±5.25)day;educational limit years(8.80±4.40).(2)Aphasia types:4 were Broca aphasics(13.33%),3 were Wernicke aphasics(10%),5 were Complete aphasics(account for 16.67%),2 were transcortical combined aphasics(6.67%),3 were transcortical motor aphasics(10%),7 were transcortical sensory aphasics(23.33%),1 were anomic aphasia(3.33%),3 Was conduction aphasia(10%),while 2 were unclassified(account for 6.67%).(3)Scores of the National Instinite of Health Stroke Scale,SADQ-H and ADL assessment were 5.70±4,53,17.53±10.48 and 45.97±18.39 respectively。All data were statistic analysied by SPSS 20.0 software.Results(1)A11 domains of language ability were significantly improved(like listening-comprehension score(139.70±72.82 VS 203.33±35.30),P<0.01).(2)Every nonlinguistic cognitive score were significantly increased within 3 months(total NLCA score(48.00125.11 VS 65.83±13.02),P<0.05).(3)The NLCA total score(62.40±14.23)and scores in visual spatial(9.95±2.67)and abstract reasoning(6.05±1.54)of persisting aphasia patients were significantly lower than that of aphasia recovered group(72.70±6.34、12.10±0.74 and 7.50±0.71 respectively).(4)Multivariate regression showed that initial NLCA score were significantly correlated with cognition of aphasia patiens 3 months after stroke(β=-0.603,P=0.000).ConclusionsThe rehabilitation of nonlinguistic cognition in aphaisa patients after first ischemic stroke is similar to that of language function,will significantly improved within 3 months.Patients with persisting aphasia may have worse performance on nonlinguistic cognition and ability of daily living,even with more serious depressive emotion.Evaluation of nonlinguistic cognition in post-stroke aphasia patients in acute phase is necessary and the score seems to be an important predicting factor of 3-month cognition.